Among patients with diabetes and acute myocardial infarction (AMI), the rates of major adverse cardiac and cerebrovascular events (MACCE) decreased from 2002 to 2019, according to a study in the International Journal of Cardiology.
Researchers assessed long-term trends in clinical characteristics, treatment, and outcomes in patients with diabetes and AMI with use of data from the prospective AMIS Plus (National Registry of Acute Myocardial Infarction in Switzerland).
Participants with ST segment elevation MI or non-ST segment elevation MI were enrolled in the registry from January 2002 to December 2019.
The primary endpoint was MACCE, a composite of all-cause death, nonfatal MI, and cerebrovascular events. The analysis was grouped into 3-year periods, and patients’ baseline characteristics were compared between the first period (2002-2004) and last period (2017-2019).
The proportion of patients with diabetes did not change during the 18-year period (P =.15). Among 49,413 patients, 20.6% had diabetes, of whom 29.4% were women. The patients with diabetes were older (P <.001) and they had a higher body mass index (P <.001), compared with patients without diabetes.
Patients with diabetes had percutaneous coronary intervention (PCI; P <.001) less frequently during the index hospitalization and were more frequently treated with coronary artery bypass grafting (CABG; P <.001) vs patients without diabetes. The proportion of patients with diabetes who had PCI or CABG increased during the 18-year period (P <.001).
The overall MACCE rates were 9.5% and 5.2% in patients with diabetes and patients without diabetes, respectively (P <.001). Diabetes was an independent predictor of MACCE (adjusted odds ratio [aOR], 1.39; 95% CI, 1.27-1.52; P <.001), mortality (aOR, 1.40; 95% CI, 1.27-1.56, P <.001), myocardial infarction (aOR, 1.42; 95% CI, 1.17-1.74; P =.001), and cerebrovascular events (aOR, 1.43; 95% CI, 1.13-1.81, P =.003).
MACCE rates decreased from 11.8% (2002-2004) to 7.5% (2017-2019) among patients with diabetes, and MACCE rates decreased from 6.5% to 5.0% in the same period among patients without diabetes (P for trend <.001 for both). Although a decrease in mortality rates (9.4% to 5.9%; P for trend <.001) and recurrent myocardial infarction (3.4% to 0.9%; P for trend <.001) was observed over time, the rate of cerebrovascular events was stable (P for trend =.34).
Comparable trends were observed in both men and women with diabetes and in patients without diabetes. The highest rates of MACCE were found in women with diabetes, with statistically significant differences occurring between women and men with diabetes in 2008 to 2010 (13.7% vs 9.8%, P =.03) and 2011 to 2013 (11.1% vs 8.1%, P =.046).
Study limitations include the observational design, and that the diagnosis of diabetes is based on data available from medical records or by the treating physician during the index hospitalization. Also, data regarding the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists are not available.
“…this study demonstrated a significant reduction in in-hospital rates of MACCE from 2002 to 2019 in patients with diabetes and AMI, mostly due to reduced rates of mortality and recurrent myocardial infarction,” the researchers wrote.
Disclosure: The AMIS Plus registry is funded by unrestricted grants from the Swiss Heart Foundation and from Abbott Medical AG, Amgen AG, AstraZeneca AG, Bayer AG, Biotronik AG, Boston Scientific AG, B. Braun Medical AG, Cordis-Cardinal Health GmbH, Daiichi Sankyo AG, Medtronic AG, Novartis Pharma AG, Sanofi-Aventis SA, Servier SA, SIS Medical Distribution AG, Terumo GmbH, and Vascular Medical GmbH. Please see the original reference for a full list of disclosures.
Stähli BE, Witassek FF, Roffi M, et al; On behalf of the AMIS Plus Investigators. Trends in treatment and outcomes of patients with diabetes and acute myocardial infarction: insights from the nationwide AMIS plus registry. Int J Cardiol. Published online August 19, 2022: 10.1016/j.ijcard.2022.08.032